Reviewed by Lew Mills, PhD, MFT

An insurance company recently claimed that if ADHD is a neurobiological disorder,
then it ought to be treated biologicallywith medications. Psychotherapy
ought to be unnecessary. This will surprise any of us who are familiar with
the extensive psychological consequences of ADHD, particularly in adulthood.
We know that ADHD has a neurobiological basis, but that far from precludes that
there are virtually always psychological implications.

So why do we focus so much on those first treatment decisions
about diagnosis and medications? Even the insurance company mentioned
above ultimately had to admit that this is a superficial approach to
treating ADHD in adults. Nonetheless, many adults diagnosed with ADHD
stop their own exploring of their ADHD once the medications are seen
to work (or not). Too often, ADHD adults fall into this medical model
of ADHD and, like the insurance company, they conclude that treatment
of their neurobiological condition ends with neurobiological
treatments.

This can lead to dangerous disappointments when the medication
does not "cure" ADHD, nor solve the heap of life's problems that have
accumulated in the pre-diagnosis years. This setback, in the context
of a life of many unexplainable failures, can lead to the discouraged
ADHD adult abandoning hopes for real change.

Sari Solden's new book takes the longer view. She elaborates on the period
from before diagnosis through a full acceptance and embracing of the authentic
self with ADHD. This life's work she sees altogether as a voyage of "three journeys."
The first journeydiscovering the diagnosis and treating it medicallyis
the most familiar. It is also the one that most other ADHD books primarily address.
And Solden also covers this ground well.

But after diagnosis and medication, what should an ADHD adult
expect? What should they try to do? The second and third journeys
pick up from this point and fills in what the ADHD adult is really
going to have to do. Reaching past advising that we all need to
self-advocate, we need to build on our strengths, that we need to
accept ourselves, Solden lays out the maps for these journeys in
detailed, practical terms.

There are many nuggets to be mined here, but I would share one of
my favorites. I often tell clients just starting work with me that
there are two jobs that they can do in therapy. The first is to
problem-solve about how to make their future work. They already
expected that one. The second, less obvious one is to revise the
history that they have created for themselves in their explanations
of the their own behavior since childhood.

Their reaction may be to tell me that when they were in therapy
before, they already had all of those "insights", and it didn't help
at all. A therapist has already asked them to consider whether they
may be expressing aggression or dependency in their irresponsible
behavior, or suggested that they may have some unconscious desire to
sabotage themselves. But these "insights" are the same toxic
attributions about their behavior that they and everyone else
inflicts on them to no avail. Like the injunction to "try harder",
there is no way that the ADHD adult can use these to improve their
ability to function. It condemns the ADHD adult for not controlling
these things which they really cannot. So the ADHD adult is carrying
a heavy load of self-recrimination that is not deserved, does not
motivate or guide them, and about which they are not even fully
aware.

So one of the greatest problems that an ADHD adult will
immediately face is that they have acquired a distorted sense of who
they are and their culpability in their difficulties. This is the
history that therapy can help them revise. The ADHD adult can
understand that the history they have created of themselves is flawed
and inaccurate. There are other explanations for themselves which do
not condemn them for not "trying harder."

Much of Solden's book revolves around how to reclaim an authentic
self in the face of this distorted history. And from that, one can
recreate a life which has gone off course. The ADHD adult has to
separate themselves and their self-worth from the symptoms of ADHD.
Solden emphasizes reconnecting with the dreams that unexplained ADHD
symptoms may have prematurely cut off. With the spark of discovering
who one really is, and recognizing one's strengths again, in the
context of their challenges, Solden envisages a new life for ADHD
adults which goes way beyond discovering how many milligrams of this
or that one must take.

Solden's narrative includes both stories of others who have been
on these journeys before and short exercises for self-exploration
around the same issues. Perhaps the hidden gem is in the appendices,
where she lays out in a more linear form all of the issue areas,
approaches that may work, pitfalls, and suggestions about how to more
forward. Some of this is detailed in the form of advice to a
potential therapist, but we know that every ADHD adult is going to
read this part of the book as well!

Solden somehow conveys the sense that she will be by your elbow as
you move along these journeys. She also advocates that you find
warm-blooded versions of her support in the people around you.

No doubt, some readers will be tempted to concretely measure
themselves against Solden's mileposts. It will be tempting to ask
whether they are finished with "Journey Two", or halfway through
"Journey Three." The answers will only be partly discernible from
this book. So much about these journeys is about how an ADHD adult
connects with others in the world, giving the gift of their authentic
self and receiving back the appreciation of others. The answer as to
whether the journey is working will inevitably have to come from
those connections themselves. Part of the journey may be testing out
where one is on these excellent maps. But the map is not the
territory, and only the journey will reveal the destinations.